Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
PATH, 2201 Westlake Avenue, Suite 200, Seattle, Washington 98121, USA.
Vaccine. 2021 Aug 16;39(35):5037-5045. doi: 10.1016/j.vaccine.2021.06.086. Epub 2021 Jul 26.
Low- and middle-income countries have a high burden of respiratory syncytial virus lower respiratory tract infections. A monoclonal antibody administered monthly is licensed to prevent these infections, but it is cost-prohibitive for most low- and middle-income countries. Long-acting monoclonal antibodies and maternal vaccines against respiratory syncytial virus are under development.
We estimated the likelihood of respiratory syncytial virus preventive interventions (current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine) being cost-effective in Mali.
We modeled age-specific and season-specific risks of respiratory syncytial virus lower respiratory tract infections within monthly cohorts of infants from birth to six months. We parameterized with respiratory syncytial virus data from Malian cohort studies, as well as product efficacy from clinical trials. Integrating parameter uncertainty, we simulated health and economic outcomes for status quo without prevention, intra-seasonal monthly administration of licensed monoclonal antibody, pre-seasonal birth dose administration of a long-acting monoclonal antibody, and maternal vaccination. We then calculated the incremental cost-effectiveness ratio of each intervention compared to status quo from the perspectives of the government, donor, and society.
At a price of $3 per dose and from the societal perspective, current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine would have incremental cost-effectiveness ratios of $4280 (95% CI $1892 to $122,434), $1656 (95% CI $734 to $9091), and $8020 (95% CI $3501 to $47,047) per disability-adjusted life-year averted, respectively.
In Mali, long-acting monoclonal antibody is likely to be cost-effective from both the government and donor perspectives at $3 per dose. Maternal vaccine would need higher efficacy over that measured by a recent trial in order to be considered cost-effective.
中低收入国家呼吸道合胞病毒下呼吸道感染负担沉重。一种每月注射一次的单克隆抗体已获得许可，可用于预防这些感染，但对于大多数中低收入国家来说，其成本过高。目前正在开发针对呼吸道合胞病毒的长效单克隆抗体和母传疫苗。
我们评估了在马里，呼吸道合胞病毒预防干预措施（现有单克隆抗体、长效单克隆抗体和母传疫苗）具有成本效益的可能性。
我们根据马里队列研究的呼吸道合胞病毒数据以及临床试验的产品疗效，为每月出生至 6 个月的婴儿队列建模，建立特定年龄和季节的呼吸道合胞病毒下呼吸道感染风险模型。我们综合考虑参数不确定性，模拟了无预防、季节性每月给予许可单克隆抗体、季节性前给予长效单克隆抗体出生剂量和母传疫苗接种的现状下的健康和经济结果。然后，我们从政府、捐赠者和社会的角度计算了每种干预措施相对于现状的增量成本效益比。
以 3 美元/剂量的价格，从社会角度来看，现有单克隆抗体、长效单克隆抗体和母传疫苗的增量成本效益比分别为 4280 美元（95%CI，1892 美元至 122434 美元）、1656 美元（95%CI，734 美元至 9091 美元）和 8020 美元（95%CI，3501 美元至 47047 美元）/每例残疾调整生命年。
在马里，以 3 美元/剂量的价格，长效单克隆抗体从政府和捐赠者的角度来看都具有成本效益。母传疫苗需要比最近的试验所测量的更高的疗效，才能被认为具有成本效益。
